Prostate cancer screening:

Should you get a PSA test?

Should
you get a PSA test to see if you have prostate cancer? This is a question
you should ask your doctor, but be prepared for a discussion — the answer
isn't black-and-white. Prostate cancer screening isn't appropriate for
everyone and should be used only for men who will benefit from detecting and
treating prostate cancer early.

Since
PSA testing became available, the death rate from prostate cancer has
decreased substantially. Despite this positive result, it's important to
realize that PSA testing isn't perfect nor is it completely clear which men
with prostate cancer benefit from aggressive treatment. Armed with
sufficient information, you and your doctor can make a reasonable decision
about PSA testing.

What is PSA?

The prostate gland is
located just below a man's bladder and surrounds the top portion of the
urethra, the tube that drains urine from the bladder. The primary function
of the prostate is to produce fluid in semen, the fluid produced during
ejaculation.

Prostate-specific
antigen (PSA) is a protein produced by both cancerous (malignant) and
noncancerous (benign) prostate tissue. PSA helps liquefy the semen and
enters the bloodstream at variable rates depending on the health of the
prostate. Because PSA is present in both benign and cancerous prostate
cells, it's not specific to only prostate cancer. However, cancer cells
usually make more PSA than do benign cells, causing PSA to rise early in the
course of prostate cancer. The complicating issue is that conditions other
than prostate cancer also can cause PSA levels to rise, including benign
enlargement of the prostate, inflammation of the prostate (prostatitis) and
other less common conditions.

Besides
the number itself, other factors that go into interpreting PSA scores
include your age, the size of your prostate and how quickly your PSA levels
are changing. Because of the complexity of these relating factors, it's
important that a physician experienced in interpreting PSAs evaluate your
situation so that you can avoid unnecessary or inappropriate invasive
testing and treatment.

Simple tests, not-so-simple decision

Because
there are no clear answers on who should have PSA screening, consider the
pros and cons of the test.

Pros
of PSA screening

Cons
of PSA screening

PSA
screening allows the early detection of prostate cancer. Cancer is
easier to treat and is more likely to be cured in the earlier stages
of the disease.

Prostate
cancer may be slow growing and never spread beyond the prostate gland.

PSA
testing can be done with a simple blood test.

PSA
tests can't tell the difference between prostate cancer and other
noncancerous prostate conditions (such as infection or noncancerous
prostate enlargement). If PSA test results are questionable, more
testing may be recommended, including prostate biopsies.

For
some men, knowing is better than not knowing. Having the test can
provide you with a certain amount of reassurance — either that you
don't have prostate cancer or that you do have it and can now have it
treated.

You
may end up with a diagnosis of prostate cancer that is not a threat to
your health and doesn't require treatment.

Prostate
cancer, if found early, can be successfully treated.

Testing
for prostate cancer may lead to unnecessary treatments. Treatment for
prostate cancer can have serious risks and side effects, including
urinary incontinence, erectile dysfunction or bowel dysfunction.

The
number of deaths from prostate cancer has gone down since PSA testing
became available.

There
is no clear evidence that the decrease in deaths from prostate cancer
is due to early detection and treatment based on PSA or due to other
factors.

Consider your age

Because
prostate cancer typically grows very slowly, after age 75, or if you have
another life-limiting condition, you may not need PSA testing.

Think about your risk factors for prostate cancer

Knowing
the risk factors for prostate cancer can help you determine if and when you
want to begin prostate cancer screening. The main risk factors include:

·Age.
As you get older, your risk of prostate cancer increases. After age 50, your
chance of having prostate cancer increases substantially. About 70 percent
of all diagnosed prostate cancers are found in men age 65 years or older.

The
option to have PSA testing begins at age 50 (40 if you have risk factors)
and continues until you're at the age when your life expectancy is 10 years
or less. Once you reach that age, the likelihood that a prostate cancer
would progress and cause problems during the remainder of your lifetime is
small, so some doctors feel the test has less value then. If you have family
members who lived long lives, the more reason to consider screening.

·Race or
ethnicity. For
reasons that aren't well understood, black men have a higher risk of
developing and dying of prostate cancer.

·Family
history. If a
close family member — your father or brother — has prostate cancer, your
risk of the disease is greater than that of the average American man.

·Diet.
A high-fat diet and obesity may increase your risk of prostate cancer.

Assess your personal preferences

How do
you feel about cancer, treatment and your overall health? Consider these
statements when making the decision whether to have PSA screening. Which
ones seem to ring true for you? Make a checkmark by the statements you agree
with.

I
worry about cancer.

I
would rather know that I have cancer than not know and worry about it.

I'm
not concerned about prostate cancer which may never affect my health.

I
don't want to undergo unnecessary testing or treatment.

I
worry about my ability to maintain an active sexual life and retain
urinary continence more than I worry about having prostate cancer.

How
you respond to these statements may leave you leaning one way or another in
your decision.

Consider the varying viewpoints:

What are the recommendations?

Organization

Recommendations

American
Urological Association (AUA)

The
AUA encourages men who are in good health to have annual PSA testing
starting at age 50, or at age 40 if they're in high-risk groups, such
as black men or those with a father, brother or son with the disease.

American
Cancer Society (ACS)

The
ACS recommends that doctors offer the tests to men age 50 and older
who expect to live another 10 years, and test men at high risk if
they're age 45 and older.

Centers
for Disease Control and Prevention (CDC)

The
CDC considers the evidence insufficient to determine whether the
benefits outweigh the harms.

U.S.
Preventive Services Task Force (USPSTF)

The
USPSTF considers the evidence insufficient to determine whether the
benefits outweigh the harms.

How does it add up?

After
considering all of the pros and cons of screening, your age, general health
and risk factors, your personal preferences and what the experts say, talk
to your doctor and together you can make an informed decision.

There's no wrong answer when it comes to PSA
testing. But it's helpful if you understand what prostate cancer screening
involves, how it works and what information it provides. Based on that
information, make an informed decision as to whether you want to pursue
screening.